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Application Form
School Retreat Participation
Applicant Information
Name
(Required)
Email
(Required)
Phone
Work Phone Number
(Required)
School Information
School Name
(Required)
Address
(Required)
Street Address
City
State
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District of Columbia
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Ohio
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Pennsylvania
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South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
Point of Contact Name
Website
Years of Attendance
Purpose of School's Participation
How does your participation benefit your students & communities?
First Choice Dates (Tuesday-Thursday)
Second Choice Dates (Tuesday-Thursday)
Third Choice Dates (Tuesday-Thursday)
Guests in Attendance
Anticipated Number of Students
Student Grades
3rd Grade
4th grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Percentage of Title 1 Qualifying
Percentage of Free and Reduced Lunch Qualifying
Anticipated Number of Adults
Anticipated Total Guests
2024-25 School Year Professional Development Days
Please list your scheduled professional development days for the coming school year.
In the current year, have you worked with any of the following programs?
San Antonio River Authority
Ghisallo Cycling Initiative
Cibolo Nature Center
Region 20
TPWD
Gardopia Gardens
Requirements
If approved to camp, I agree that our group will arrive within the required time frame and stay in our campsite until we are released after check out.
(Required)
I Agree
I understand that a first aid provider must be on-site at all times during our camp stay; H. E. Butt Foundation Camp does not supply first aid providers. At a minimum, a person with an American Red Cross Community First Aid and Safety Certificate or equivalent (Community First Aid, CPR, AED) must be with our group at all times. Copy of current license or certificate must be submitted to H. E. Butt Foundation Camp staff at least ONE MONTH before our arrival.
(Required)
I Agree
I understand that our group must provide our own lifeguards; H. E. Butt Foundation Camp does not provide lifeguards. All waterfront activities must be attended and supervised by an adult (18 years old or older) who holds a current American Red Cross Lifeguard certification or its equivalent. A minimum of one certified lifeguard per 20 swimmers is required. Copy of current certificate must be submitted to H. E. Butt Foundation Camp staff at least ONE MONTH before our arrival.
(Required)
I Agree
I understand that we must provide proof of commercial general liability insurance to $1 million. Proof of insurance must be faxed or mailed to H. E. Butt Foundation Camp staff at least ONE MONTH before our arrival.
(Required)
I Agree
I understand that a representative of our organization must sign an Indemnity Agreement before our group participates in H. E. Butt Foundation Camp. Agreements must be signed and submitted to H. E. Butt Foundation Camp staff at least ONE MONTH before our arrival.
(Required)
I Agree
I understand that for the safety and well-being of all participants, H. E. Butt Foundation Camp encourages all adult attendees to complete abuse awareness training. This training only takes a matter of minutes and provides valuable insight in maintaining the highest standards for student safety. One available source for this training is easily accessed through the Boy Scouts of America website: my.scouting.org. Their training is free with a BSA account and takes about an hour.
(Required)
I Agree
I understand that my organization is responsible for all our food, supplies, meal preparation and thorough cleanup.
(Required)
I Agree
I understand that our organization is responsible for conducting background checks for each of our adult volunteers.
(Required)
I Agree
I understand that I must submit an agreement to comply with the Texas Department of State Health Services requirements.
(Required)
I Agree
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